Background Systemic Sclerosis (SSc) is a chronic autoimmune disease characterized by proliferative vascular lesions and progressive fibrosis of skin and internal organs, including the gastrointestinal tract. Gastrointestinal involvement is a very frequent complication, reported in up to 90% of SSc patients in both limited (lSSc) and diffuse (dSSc) cutaneous forms, and it is one of the earliest events.
Objectives To evaluate the correlation between radiological items analyzed by videofluoroscopy swallow study and clinical patterns of patients SSc.
Methods 55 patients (M/F: 6/49; median age 56y; median disease 6y, lSSc /dSSc:36/19; anti-Scl70+:21/55, ACA+:18/55, only ANA+:16/55), with a diagnosis of SSc and a history of dysphagia underwent a dynamic and morphological study of the oral, pharyngeal and esophageal phases of swallowing with videofluoroscopy. The oral and pharyngeal esophageal phases were performed in the upright position, while the esophageal phase was performed in the prone-oblique position, after administration of contrast material either in bolus form or diluted. Data were analyzed by radiologist with experience in videofluoroscopy for the evaluation of 17 videofluoroscopy items, of which, 4 concerning the oral, 4 the pharyngeal and 9 the esophageal phase, respectively. Results were expressed in a binary system. Then the main relevant videofluoroscopy findings were correlated with the principal scleroderma pattern of disease: lSSc vs dSSc; disease duration (more than 2 years) and subset of autoantibodies.
Results Radiological study of swallowing disorders showed for oral phase: inadequate velar elevation in 4%, leakage in 15%, drooling in none (0%) and stasis of bolus in mouth in 4% of the patients. As for pharyngeal phase: stasis of bolus on pharyngeal in 49%, penetration in the laryngeal aditus in 53%, post-swallowing aspiration in 22%, abnormal upper esophageal sphincter behavior in 13% of the cases. Concerning esophageal phase: inadequate primary peristalsis in 53%, abnormal secondary peristalsis in 29%, non-peristaltic contractions in 40%, defects of clearance in 69%, abnormal lower esophageal sphincter behavior in 76%, hiatal hernia in 80%, esophageal reflux in 56%, esophagitis in 82% of the patients, nobody presented esophageal luminal stenosis. When we analyzed the swallowing disorders in different conditions we found that these are prevalent in patients with more than 2 year of disease, although may be found also early. Conversely, we have not found a significant prevalence between the lSSc or the dSSc, or a particular correlation with different patterns of autoantibodies.
Conclusions Our study demonstrated relevant abnormalities in swallowing functions in high number of patients with SSc. Pharyngeal and esophageal phases are the most affected, also early. Swallowing disorders increase with disease progression and involve similarly the limited or the diffuse SSc. An early and detailed diagnosis, supported by a semi-quantitative analysis with the use of videofluoroscopy scores, may be useful to guide the appropriate therapeutic approach, either rehabilitative or pharmacological, and finally, to improve the patient's quality of life. Extensive studies are necessary to confirm and transfer our data into clinical practice.
Disclosure of Interest None declared